Ethical Perspectives on Suicide and End-of-Life from Aristotelian Virtue Ethics to Modern Psychoanalytic Approaches: a critical appraisal and review of literature
J. Eberlein, M. Chorianopoulou, C. DokosIntroduction
Ethical debates on suicide and end-of-life choices have evolved significantly over time. Aristotle’s virtue ethics emphasized that human flourishing ( eudaimonia ) depended on moral character as well as sound judgment, including decisions about life and death (MacIntyre A. After Virtue. 3rd ed. Notre Dame: University of Notre Dame Press; 2007). However, modern debates are more focused on autonomy, beneficence, and the clinician’s duty towards preserving life, particularly within psychiatric settings.
Objectives
To critically appraise historical and contemporary ethical frameworks on suicide and end-of-life decisions, with particular emphasis on the transition from virtue ethics to modern psychoanalytic approaches.
Methods
A conceptual literature review was conducted, analyzing philosophical, psychiatric, and ethical sources. Key themes included virtue ethics, principles of biomedical ethics, psychodynamic theories of suicidality, and relational models of autonomy.
Results
The review shows a continuous shift in ethical reasoning about suicide and end-of-life care, moving from character-based to principle-driven and relational approaches. Virtue ethics emphasized the importance of moral character and the pursuit of a meaningful life within the community, whereas modern frameworks focus on autonomy while also incorporating relational dimensions (Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 8th ed. Oxford: Oxford University Press; 2019). Psychodynamic perspectives enrich this discussion by highlighting the influence of hopelessness, guilt, and interpersonal dynamics in suicidality (Maltsberger JT. The descent into suicide. Int J Psychoanal. 2004;85(3):653–670). More recent research promotes relational autonomy, emphasizing family involvement and community values in guiding end-of-life decisions (Dove ES, Kelly SE. BMC Med Ethics 2015;16:45). Together, these perspectives demonstrate how ethical analysis has expanded from the individual to the relational and societal level, offering clinicians a more comprehensive framework for practice.
Conclusions
The evolution from Aristotelian virtue ethics to psychoanalytic and relational approaches marks a shift towards a more nuanced perspective on suicide and end-of-life care. Thus, integrating autonomy, beneficence, and relational ethics provides clinicians with a balanced and compassionate framework for practice.
Disclosure of Interest
None Declared